Aims to evaluate the diagnostic accuracy of EUS-guided tissue acquisition performed with
the newly designed Acquire-S needle in the differential diagnosis of solid lesions.
Methods The study identified patients from a prospective EUS registry who underwent EUS-guided
tissue acquisition for solid lesions using the new Acquire-S needles (Boston Scientific),
a franseen type needle with a modified taper point stylet. The EUS procedures were
performed using linear Pentax or Fujifilm echoendoscopes and Hitachi systems. For
tissue acquisition, both 25-gauge and 22-gauge Acquire-S needles were used. Samples
were collected in a cytological solution (Cytolit) processed for cyto-histological
evaluation. Results are shown as mean±standard deviation or percentages as appropriate.
Diagnostic accuracy was analyzed using the histopathological evaluation of the surgical
specimens, and the clinical and radiological long-term follow-up in non-operated patients,
as gold standard.
Results 89 patients (mean age 63.7 years [range 37-86 years], 41 females) were finally included.
The average size of the lesions was 26.8±19.5 mm. 51 (57.3%) were solid pancreatic
lesions, 17 (19.1%) lymph nodes, 5 (5.6%) solid liver lesions, 4 (4.5%) subepithelial
lesions, 4 (4.5%) gastric tumors, 3 (3.5%) lesions at left adrenal gland, 2 (2.2%)
ampullary lesions, 1 (1.1%) duodenal lesion, 1 (1.1%) renal tumor, and 1 (1.1%) peritoneal
implant. For tissue acquisition, in 8 (8.9%) cases the access was transesophageal,
in 48 (53.9%) cases transgastric and in 33 (37.2%) cases the access was transduodenal.
A 25-gauge needle was used in 30 cases (33.7%) and a 22-guage needle in 59 cases (66.3%).
The mean number of passes was 1.3±0.4. In 11 cases the final diagnosis was a benign
lesion, being a malignant lesion the remaining 78 cases. In 4 cases (4.5%), there
was a need to exchange the needle size (2 solid pancreatic lesions at pancreatic tail,
1 at uncinate process and 1 liver lesion), in 3 cases from a 22-gauge to a 25-gauge,
and in 1 from 25-gaugen to 22-gauge (all Acquire-S). Diagnostic sensitivity, specificity,
positive predictive value, negative predictive value and overall accuracy for malignancy
were 86.89% (95%CI 77.6-96.2); 96.43% (95%CI 87.8-100); 98.2% (955CI 93.6-10); 77.1%
(95%CI 61.8-82.5) and 89.9% (95%CI 83.1-96.7), respectively. A specific final diagnosis
could be obtained in 80 cases (89.9%). No complications were reported.
Conclusions EUS-guided tissue acquisition with the newly designed Acquire-S needle is very accurate
and safe in the evaluation of solid lesions.
